Elsevier

Mayo Clinic Proceedings

Volume 73, Issue 10, October 1998, Pages 977-982
Mayo Clinic Proceedings

Review
Over-the-Counter Stimulants: Abuse and Addiction

https://doi.org/10.4065/73.10.977Get rights and content

A widely held belief is that amphetamine-like stimulants have abuse potential, but addiction to these drugs is seldom mentioned. We describe seven patients who fulfilled criteria for amphetamine-like abuse or dependence, based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. This case series lends. clinical support to the research findings that amphetamine-like drugs are reinforcing and therefore can be addictive.. The use of standardized criteria to classify excessive over-the counter stimulant use as abuse or dependence distinguishes these case reports from others in the medical literature, Public concern about the misuse of this class of drugs is discussed. We propose that clinicians use standardized criteria to diagnose accurately abuse of or dependence on over-the-counter stimulants for a better understanding of the extent of this problem.

Section snippets

Vignette

A 33-year-old woman was admitted for inpatient treatment of stimulant dependence after an 18-month history of ephedrine use was discovered. She began taking two 25- mg capsules per day for appetite suppression. During the next year, her dosage escalated to approximately 60 cap sules per day. She maintained her supply by purchasing ephedrine OTC and by stealing it from work, which eventually led to her termination. Her numerous attempts to discontinue use of ephedrine failed because of rebound

Abuse And Addiction Liability

The abuse liability of OTC stimulants is controversial, although several studies have sought to resolve this debate. Chait and associates13,14 conducted human studies of the reinforcing and subjective effects of ephedrine and of PPA and concluded that both have a low abuse potential. In Chait's 1994 study of ephedrine,13 he used a double-blind, discrete-trial choice procedure to assess the reinforcing effect of ephedrine versus placebo. Twenty-seven adult subjects without substance dependence

Conclusion

The FDA has accumulated many reports of medical problems caused by amphetamine-like products. Our report highlights the additional risk of abuse and addiction to these substances, adding support for further FDA and DEA involvement. The cases presented herein are certainly not the first reports of OTC stimulant abuse. They are, however, presented in a manner that accurately defines them as amphetamine-like substance use disorders that meet DSMIV diagnostic criteria. For most patients, the weaker

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